Brain Stimulation Rouses Minimally Conscious Man

Aug. 1, 2007— -- For six years, the patient lay silent -- unable to move, eat or speak after suffering a traumatic brain injury from a blow he received to his head during a robbery.

When conventional attempts to rouse him from his minimally conscious state proved unsuccessful, doctors tried a novel and experimental approach. They inserted long, thin electrodes deep into the patient's brain.

Almost immediately after the first day of treatment, the 36-year-old man became more alert, shifting his eyes around the room to follow the movements of doctors and his loved ones.

Gradually, over the six-month course of the treatment known as deep brain stimulation, other improvements followed.

The patient was able to sit up and eat food that was fed to him. He could respond consistently to questions by mouthing yes or no. He could drink out of a cup. And, best of all, he began to speak, telling his mother and father that he loved them.

"After the procedure was over with, he can watch a movie without falling asleep. He can drink, he can laugh and cry," said the patient's mother during a teleconference Wednesday morning. Neither she nor her son was identified to the press. "I still cry every time I see my son, but now it's tears of joy."

The science behind this stunning recovery was published Wednesday in the journal Nature.

Researchers implanted tiny electrodes controlled by an external brain pacemaker into the brain of the patient, which functions like a pacemaker for the heart.

The electrodes were turned on for 12 hours a day, and shut off for the other 12 hours.

Before this experiment, the therapy had been used in patients with severe Parkinson's disease, as well as for people with anxiety disorders or who suffered a loss of hearing. But this was the first time that deep brain stimulation had helped someone in a minimally conscious state.

"Minimally conscious patients cannot communicate," said lead study author Nicholas Schiff of the Weill Cornell Medical College department of neurology and neuroscience during the teleconference. "One of the reasons we thought patients in this state would benefit from DBS is that they showed that the intrinsic systems may still be there, and could be restored."

In contrast to patients in a persistent vegetative state, minimally conscious patients show signs of arousal and knowledge of their environments but only in a limited way.

The researchers estimate that 112,000 to 280,000 such patients are in the United States. These patients with little hope of recovery are often relegated to nursing homes.

"This work is really about the patients with traumatic brain injuries," said Dr. Ali R. Rezai, the Cleveland Clinic neurosurgeon who performed the operation to implant the electrodes. "This group of patients are often young people, forgotten about by everyone except their families and caregivers. It is our responsibility to continue to explore all the ways of treating them."

Deep brain stimulation has already been used in 35,000 to 40,000 patients to treat a variety of neurological problems, from Parkinson's to hearing loss. Doctors who use the technique say that it makes sense that the electrical stimulation would work to help patients in a minimally conscious state.